Friday, October 05, 2007

The Efficient EMR

I am currently in the office three days a week (I am taking a course at the University of Toronto Mondays, and do research projects on Fridays). My roster size is at 1,320 patients and I have about 100 to 150 unrostered patients. That makes a practice of about 1,450 patients.

In my FHN, the average practice is about 1,200 patients. I have a slightly larger than average practice.

If a patient is not too particular about the time of the appointment, they can almost always be fitted in within a few days, and often the next day. The only appointments that are troublesome are full check-ups booked in the morning (so that a patient can get fasting blood work done at my office on the same day). If they can get their blood done prior to the visit, the appointment can be scheduled much sooner; we mail them the requisition along with a list of labs (only ones that do electronic results) and weblinks to lab locations. This is in the Handouts section of my EMR.

The university provides hotspots for students, so I log on to my practice on Mondays; I am usually logged on remotely Fridays as well. I can review results and reports, and assign needed actions to my staff or my practice nurse.

What that tells me is that there is less need for my patients to come in personally for minor problems. If they do need to come in, they can usually be see fairly quickly. Much of this increase in efficiency has been gained by using the capabilities of the EMR (remote access, e-communication), along with having the entire practice work as a team. It helps to have excellent staff. I am starting to see some improvements with my new nurse coming on board, and expect to see more as other Allied Health Professionals join us. My Family Health Team now includes dietitians (I've made several referrals already), and I met our new Social Workers yesterday. The RN and our Clinical Pharmacist already enter data directly into the electronic chart-in-common; the other AHP's will get training; for now, their notes are done on paper and are scanned in.

If I can look after a full roster on reduced hours, this tells me that I may be able to expand my practice if I go back to my regular hours. This is part of the payback for EMR and for adding extra people to primary care. I will have to decide whether I should do more research or see more patients.

I have now taken on a new physician as a partner; she will start in December, and will have an EMR practice from the beginning. We are already starting to keep a list of people wanting to join her practice. I think most of the pain happens during the transition; once an EMR is established (meaning that all the new processes work), it is much easier to add a new member to a practice. I have seen this with my resident. That bodes well for the next generation of physicians, provided that they do not start a paper-based practice.

My nurse will be giving my patients flu shots on a drop-in basis every Monday afternoon, once the shots are available. We will be doing a mail-out to my older patients to notify them of this. We are doing the mailing as a group, just as we did for the other preventive services: the letters are already in everyone's EMR; our FHN admin will print and mail them as soon as we have confirmation that the shots have been delivered to our offices. Several of my colleagues have also decided to have the RN run the flu shot clinic in their office.

It is increasingly difficult for me to remember what it was like to run a paper-based office; I am pretty sure that I would find the inefficiency and lack of communication difficult to tolerate. I no longer believe that paper-record based medical care has a future.


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